Clinical outcomes of children treated with intravenous prochlorperazine for migraine in a pediatric emergency department

J Emerg Med. 2010 Aug;39(2):166-73. doi: 10.1016/j.jemermed.2008.08.012. Epub 2009 Jan 15.


Background: Prochlorperazine is the only treatment that has been studied so far in a randomized controlled trial and found to reduce pain at 1 h in children with migraine who presented to an emergency department (ED).

Objective: To evaluate the rate of treatment failure associated with prochlorperazine used in children with severe migraine in a pediatric ED.

Methods: This study was a retrospective chart review of patients < 18 years of age who visited the ED of a tertiary care pediatric hospital between November 2005 and June 2007. All patients diagnosed with migraine by the emergency physicians were included in the study. Charts were evaluated by a data abstractor blinded to the study hypothesis using a standardized datasheet. Inter-rater agreement was measured. Prochlorperazine treatment failure was defined as either administration of further rescue therapy, a hospitalization, or a return visit to the ED within 48 h for symptom recurrence or side effects from the medication.

Results: Prochlorperazine was administered in 92 episodes of migraine, including 43 confirmed by a pediatric neurologist; all received diphenhydramine to prevent akathisia. A total of 13 (14%) of these patients had a treatment failure: 8 patients received one or more further rescue therapies after the administration of prochlorperazine; 5 patients were hospitalized, including 3 who had received further rescue therapy; and 3 patients returned to the ED within 48 h due to symptom recurrence.

Conclusion: There was a treatment failure rate of 14% with the use of prochlorperazine in association with diphenhydramine for severe migraine in children seen in a pediatric ED.

MeSH terms

  • Adolescent
  • Child
  • Diphenhydramine / administration & dosage*
  • Dopamine Antagonists / administration & dosage*
  • Drug Therapy, Combination
  • Emergency Service, Hospital
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Infusions, Intravenous
  • Male
  • Medical Audit
  • Migraine Disorders / drug therapy*
  • Pain Measurement
  • Prochlorperazine / administration & dosage*
  • Retrospective Studies
  • Treatment Failure


  • Dopamine Antagonists
  • Hypnotics and Sedatives
  • Diphenhydramine
  • Prochlorperazine